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INDONESIA: HIV traps women and girls in poverty

The number of reported HIV cases has tripled in Indonesia in recent years, curtailing productivity and trapping affected girls and women, especially, in poverty, according to a recent UN Development Programme (UNDP) report.

Women, representing a quarter of all people living with HIV in Indonesia, shoulder family finances when their partners can no longer work, or when they face education and employment discrimination, said the report.

“Discrimination against people with AIDS is still very strong in Indonesia, especially for women. Many HIV-positive women are being called ‘bad women’ or ‘bad girls’, but at the same time, many of them have to work more after their husbands were diagnosed with HIV,” said Chya Wibisono, an HIV-positive officer at the local NGO,Indonesia Women’s Positive Network.

Women in HIV-affected households put in longer hours but were less likely to own their homes, livestock and vehicles. They were also more likely to be widowed and denied inheritance rights – the case for 71 percent of all HIV-affected widows.

Compared with non-HIV-affected families, affected families in Indonesia were 38 percent more likely to live below the international poverty line of US$1.25 per person per day – the second highest of all the countries surveyed – with more than a quarter of these households reporting having to sell assets to pay medical costs, the report says.

While antiretroviral therapy (ART) for HIV is provided free, the medication has reached about half of patients in need, compared with 94 percent in Cambodia, where free ART coverage has proven to be effective in reducing households’ financial burden, according to the UNDP report.

“Real [progress] has been made to improve ART coverage in Indonesia. The percentage of coverage has increased significantly from 25 to 50 percent over the last three years, but this is still far from enough,” said Nancy Fee, country coordinator of UNAIDS in Indonesia.

As of December 2009, some 18,000 people had reported HIV at an advanced stage, of whom 6,653 were receiving ART, according to the government.

People were going without medication mostly because they had not tested for HIV and did not know their status; in addition, continuity and availability of ART stock as well as availability of certified health workers to administer the drugs were challenges, according to the government.Daughters in HIV-affected families were also more likely to be pulled out of school than sons to take care of their sick family members.

“It is most often [girls] who are removed first. This is both to save resources spent on schooling, as well as to utilize the girl child for labour,” said Clifton Cortez, health and development practice leader at the Bangkok-based UNDP Asia-Pacific Regional Centre.

The UNDP report suggested conditional cash transfers – paying children based on their school enrolment and attendance – to encourage parents to keep children in school.

According to the World Bank, the risk of HIV infection is more than halved for young people, particularly girls, who stay in school and complete a basic education.

In Indonesia, 28 percent of women surveyed between the ages of 15-24 had not heard of HIV and had little knowledge of condom usage, said the UNDP report.

However, Nafsiah Mboi, secretary of the government’s National AIDS Commission, dismissed concerns that women and children bore the economic brunt of HIV.

“There is no specific scheme for HIV-affected families or women, but everyone who is poor can ask for assistance. There is no discrimination,” she said.

While a National Social Security System (SJSN) has been in place since 2004 – a basic framework for reforming the country’s social security programme covering health insurance, employment injury, pensions and death benefits – the International Labour Organization estimated 54 percent of the country’s population (mostly workers in the informal economy, employees without contracts and their families) were still excluded in 2011 from the national social health protection scheme.

Instead of small government-funded isolated projects, Fee from UNAIDS said the country needed a “universal social protection floor” – a minimum level of essential social services and income security for all in times of economic and financial crisis – to ensure everybody, including those affected by HIV, had equal access to healthcare and other social services.

Parliament approved legislation on 28 October that aims to implement SJSN and provide universal health insurance coverage by 2014.